What are the critical incidents that affect how people cope with being detained under Section 136 of the Mental Health Act (1983, 2007)? [2019]

Purpose: Section 136 (S136) of the Mental Health Act (1983, 2007) provides legislative powers for police officers to detain those suspected of being ‘mentally disordered’ for a mental health assessment. Despite its increasing use, there is currently little qualitative research exploring detainee’s experiences.

Methodology: Participants recruited from NHS places of safety participated in a semi-structured interview. The novel application of Critical Incident Technique (CIT) within this study enabled the specific identification of critical incidents which mental health service users thought had either helped with, or worsened the S136 detention experience. A wish list of absent factors was also gathered.

Findings: Six categories of helpful critical incidents, seven categories of unhelpful critical incidents and five categories of wish-list items were identified. The importance of authentic relationships underpinned many categories, as well as challenging stigma, considering previous detentions; and receiving practical support.

Originality/value: The outlined study is the first of its kind to utilise CIT methodology to specifically identify critical incidents related to the process of S136 detention. These findings provide specific ways to improve the experience of detention informed directly by those who have been directly subjected to S136.

Key points

  • Take time to invest in meaningful relationships with those who are detained; asking about the individual’s life experience and their perception of its relationship to their current presenting difficulties.
  • Identify the service user’s values -what’s important to them, and what gives meaning to their life – and discuss this in relation to what their worries, concerns or wishes may be for treatment.
  • Discuss previous experiences of involuntary admission- this can support all parties involved to consider the impact of detention upon the individual, and services.
  • Use problem-free discussions to normalise and help de-stigmatise mental health difficulties and support rapport building.
  • Provide practical support, such as food, drink and routinely allow those who are detained to gather personal belongings such as a change of clothes or a book.
  • Ensure advocacy services are always available and accessible for those who are detained under S136.
  • Where possible, avoid the use of restrictive or stigmatising practices in front of the public where possible (e.g. use of handcuffs, police vehicles as transport) to minimise risk of increasing mental health stigma.

Thomas Goodall, Elizabeth Newton & Michael Larkin
International Journal of Psychiatry in Clinical Practice, 08 Mar 2019